Reoperative Minimally Invasive Surgery for the Management of Colorectal Surgical Complications

Eric M Haas, MD, Rodrigo Pedraza, MD, Chadi Faraj, DO, Madhu Ragupathi, MD, T. Bartley Pickron, MD

Colorectal Surgical Associates, Ltd, LLP / Minimally Invasive Colon and Rectal Surgery, Department of Surgery, The University of Texas Medical School / Michael E. DeBakey Department of Surgery, Baylor College of Medicine / Houston, TX

Introduction: Minimally invasive colorectal surgery has shown to afford several short-term benefits over open surgery including enhanced recovery, shorter length of stay, and diminished complication rates. Furthermore, wound complications such as infection and hernia are reduced with the minimally invasive techniques. Nevertheless, complications following minimally invasive colorectal may warrant reoperation in 2-10% of cases. Traditionally, these secondary interventions require an open approach with associated morbidity, including wound infections, delayed wound healing, and ventral hernia formation with the necessity of additional surgery. We evaluated outcomes of minimally invasive reoperations performed for the management of complications after laparoscopic colorectal resections.

Methods: From August 2006 to August 2012, consecutive patients who underwent laparoscopic reoperation within 30 days following elective minimally invasive colorectal resection were included in this study. The procedures were performed by one of two board-certified colorectal surgeons in two institutions in the Texas Medical Center (E.M.H and T.B.P). Preoperative characteristics and perioperarive short-term outcomes within 30 days following discharge after the secondary procedure were evaluated.

Results: Over a 6-year period, a total of 889 patients presented for elective laparoscopic colorectal resection. A total of 31 (3.5%) patients required reoperation within 30 days of the index surgery. Of these, 10 patients (32.3%) had reoperation with the utilization of a minimally invasive approach and made the cohort for this study. There were 7 male and 3 female patients, the mean age, body mass index, and median ASA was 56.0±16.2 (range: 20-81) years, 26.8 ± 4.4 (range: 22.1-37.4) kg/m2, and 3 (range: 2-4), respectively. Indications for reoperation included anastomotic dehiscence (n=6), followed by intra-abdominal abscess (n=3), and infected hematoma (n=1). The procedures were performed with conventional multiport laparoscopic surgery in 6 cases, hand-assisted laparoscopic surgery in 3 cases, and one case was performed with a single-incision laparoscopic technique. All procedures consisted of peritoneal lavage and drainage with 6 cases requiring diverting ostomy creation. The mean operative time was 109.7 ± 46.0 (range: 64-213) min with an estimated blood loss of 72.5±52.0 (range: 25-200) cc. There were no intraoperative complications and only one case required conversion to laparotomy. The mean post-procedure length of hospital stay was 14.5±10.8 (range: 4-38) days. There were no wound infections and only one patient developed further complications. There were two readmissions and two reoperations for persistent intra-abdominal abscess.

Conclusions: Complications requiring surgery following laparoscopic colorectal resection may be successfully managed, in selected cases, with a minimally invasive surgical technique. Rather than the traditional enhanced recovery benefits of minimally invasive surgery, in the setting of reoperation, the benefits of laparoscopic surgery are based on the avoidance of large laparotomy incisions, which increase the risk of large hernias and wound infection, especially when an ostomy is created.

Session: Poster Presentation

Program Number: P123

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